Wrist Algodystrophy Complicating Overdistraction of Distal Radial Fractures

Abstract

Many publications list algodystrophy as one of the most common and disabling complications of distal radius fractures. Presented data suggest many possible factors leading to its development, where median nerve injury is an important risk factor. the aim of the study was to present our experience with such complications after hybrid external fixation of distal radius fractures. The operative procedure, as well as clinical symptoms of algodystrophy are described in details. material and methods. Among 14 patients with neglected or after secondarily displaced distal radius fractures treated with hybrid external fixator three developed algodystrophy, in two cases refractory to our management protocol. The operation was performed at three to five weeks after injury. All cases with algodystrophy had a period of overdistraction of bone fragments. These patients had electromyographic studies performed. This examination revealed serious damage to the median nerve in all cases. Additionally all of them presented with serious bone atrophy of the wrist as documented on radiograms. Results. A year after fracture all have persisting radiographic symptoms of wrist osteoporosis and two have poor functional result despite union of bone fragments in good anatomic alignment. conclusions. Prolonged overdistraction of bony fragments in distal radius fractures may produce injury to the median nerve and result in algodystrophy.